Alunbrig (brigatinib)

Brigatinib is a tyrosine kinase inhibitor that may be used for ALK-positive (anaplastic lymphoma kinase) metastatic (has spread to other parts of the body) non-small cell lung cancer (NSCLC). Monitoring of individuals on brigatinib is essential, as there is an increased risk of developing certain side effects, such as interstitial lung disease/pneumonitis, hypertension, and abnormally slow heart rate while taking the medication.¹ Brigatinib is an orally administered tablet.

How does brigatinib work?

Brigatinib's active ingredient is a tyrosine kinase inhibitor, working specifically to inhibit the phosphorylation of certain proteins in the body. Phosphorylating a protein, or adding a phosphate group, can activate a protein to carry out a specific function. When the function of an active protein is harmful to our body, such as contributing to the development and spread of cancer, it is important to disable or turn it off by preventing its phosphorylation. Specifically, brigatinib works to disable proteins like ALK, ROS1, insulin-like growth factor-1 receptor, and other mutated proteins. Brigatinib also prevents the action of other proteins that depend on the activation of brigatinib-targeted proteins, essentially stopping a chain reaction-like process from occurring and contributing to cancer development and spreading.

What are the possible side effects of brigatinib?

Multiple clinical trials evaluated the safety and efficacy of brigatinib. The most common side effects of brigatinib include:

• Fatigue
• Nausea
• Cough
• Diarrhea
• Headache
• Muscle pain
• High blood pressure
• Vomiting
• Shortness of breath
• Rash

This is not an exhaustive list of all potential side effects of brigatinib. Talk to your healthcare provider or pharmacist for further information.

Things to note about brigatinib

Several less common but more serious side effects can accompany brigatinib, including life-threatening swelling of the lungs. Signs of this are often shown within the first week of treatment, and can be similar to original lung cancer symptoms. It is important to monitor for any changes or worsening in the following symptoms upon starting brigatinib, and alert your healthcare provider immediately if they occur:

• Fever
• Cough with or without mucus
• Chest pain
• Shortness of breath or trouble breathing

Brigatinib can also increase your risk of developing high blood pressure (hypertension), abnormally slow heart rate (bradycardia), inflammation of the pancreas (pancreatitis), and muscle weakness, pain, or tenderness (myalgia). Your doctor will monitor you for any signs of these issues; however, if you notice any signs that these may be occurring, such as dizziness, shortness of breath, feeling faint, upper abdominal pain, or changes in muscle pain or function, alert your provider immediately.

Brigatinib can also cause vision problems. It is important to alert your healthcare provider immediately if you notice any of the following symptoms:

• Seeing flashes of light or sensitivity to light
• Blurry vision
• Double vision
• New or increased floaters

Brigatinib can also increase blood sugar levels and lead to hyperglycemia. While your provider should monitor for this as well, it is important to alert them if you notice any of the following:

• Feeling very thirsty or hungry
• Feeling confused, weak or tired
• Feeling sick to your stomach
• Needing to urinate more than usual

Before starting brigatinib talk to your healthcare provider about all your health conditions, including if you:

• Have high blood pressure
• Have a slow heartbeat
• Have lung or breathing problems
• Have a history of pancreatitis
• Have a history of diabetes mellitus or glucose intolerance
• Are pregnant or are planning to become pregnant. Brigatinib can harm an unborn baby.
• Are breastfeeding or planning to breastfeed. It is not known if brigatinib can pass through breast milk.
• Are taking any other medications (prescription or over-the-counter), vitamins, or natural supplements

Brigatinib can cause harm to a developing fetus and should not be taken by women who are pregnant. While taking brigatinib, males with female partners who can become pregnant, and females who can become pregnant, should both use contraceptives during treatment and for a period of time after completing treatment (patients should discuss appropriate birth control methods, and how long they need to use them, with their doctor). Females should not breastfeed during brigatinib treatment and for a period of time following the final dose (patients should discuss breastfeeding considerations with their doctor).

Receiving brigatinib

Brigatinib is an oral tablet. Your doctor will determine the appropriate dosage for you. Do not change or stop taking your Alunbrig without talking to your doctor. Patients should take their medication as prescribed by their doctor. Patients should talk to their doctor if they have any questions, or if they have questions regarding their brigatinib regimen.